Less EVALI Cases Occurs in States With Legalised Marijuana

EVALI stands for e-cigarette or vaping use-associated lung injury. It was originally known as VAPI (vaping associated pulmonary illness). The new name is in response to a growing number of severe lung illness cases related to using e-cigarette and vaping products, the first being identified during 2019. We are still learning about this disease, so changes may continue to be made to the terminology.

A study published by JAMA Network Open earlier last April, had indicated that the occurrence of EVALI was less common in US States where marijuana products are legal. “Our results are suggestive that those in recreational marijuana states may be less likely to purchase illegal marijuana products on the black market,” said Dr. Alex Hollingsworth, assistant professor in the O’Neill School of Public and Environmental Affairs at Indiana University and co-author of the JAMA Network Open study.

Less EVALI cases in states where marijuana is legal

Similarly, recent data published in the journal Addiction reported a negative relationship between the occurrence of EVALI and the availability of legal marijuana markets. “A negative relationship between EVALI prevalence and rates of pre-outbreak vaping and marijuana use suggests that well-established markets may have crowded-out use of riskier, informally sourced e-liquids.”

“Indeed, the five earliest states to legalize recreational marijuana — Alaska, California, Colorado, Oregon and Washington — all had less than one EVALI case per 100,000 residents aged 12 to 64. None of the highest EVALI-prevalence states — Utah, North Dakota, Minnesota, Delaware and Indiana — allowed recreational marijuana use.”

EVALI patients showed GI symptoms

Meanwhile, a study looking at a different aspect of the condition conducted by UT Southwestern researchers, found that most teens diagnosed with EVALI, also presented with gastrointestinal symptoms and a history of psychosocial factors, such as substance abuse.

“This is the first study on teens and EVALI from UT Southwestern, and one of the first in the country regarding clinical features of EVALI in the pediatric population,” said study author Devika Rao, M.D., a pediatric pulmonologist at Children’s Health and assistant professor of pediatrics in the division of respiratory medicine.

Rao pointed out GI symptoms in these teens were as common as their lung injury symptoms. “We found that teenagers often presented with GI symptoms, which were just as frequent as respiratory symptoms. In some cases, these teens had abdominal CT scans that ended up showing abnormalities in the lung, which was the first clue of lung injury.”

Additionally, she added, there was a larger proportion of these patients than reported who were female and hispanic. “It may be that in the adolescent population these groups are more vulnerable to risky behaviors than what was previously thought. This serves as a reminder to clinicians that a teen with EVALI is not necessarily always going to be white and male.”

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